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Background: Patients often need to use their arms to assist with functional activities, but after open heart surgery pushing with the arms is limited to minimize force across the healing sternum. Objectives: The main purposes of this study were to determine: 1) how accurately patients can estimate arm weight bearing with 10 lb or less of force and 2) if feedback training is effective for improving ability to estimate arm force and reduce pectoralis major muscle contraction during functional activities. Materials and Methods: An instrumented walker was used to measure arm force during functional mobility tasks including walker ambulation and sit-stand transfers. Pectoralis major muscle electromyography (EMG) activity was measured simultaneously in study participants (n = 21). After baseline testing, study participants underwent a brief session of visual and auditory concurrent feedback training. Data analyses included t-tests, ANOVA, and Pearson correlations (P<0.05). Results: Results showed that self-selected arm force was greater than 10 lb for all tasks (11.7-19.0 lb) but after feedback training, it was significantly lower (8.3-9.8 lb). During most trials (67%), study participants used more than 12 lb of arm force. Pectoralis major muscle EMG values were less than 10% of maximal voluntary contractions and were reduced (2.7-3.3%) after feedback training. Conclusions: Results indicate that patients may not be able to accurately estimate upper extremity force used during weight bearing activities, and that visual and auditory feedback improves accuracy. Activation of the pectoralis major muscle during arm weight bearing is minimal, suggesting minor force occurs across the sternum. An instrumented walker and feedback training appear to be very clinically useful for patients recovering from open heart surgery.
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Background: Diabetes is not uncommon in patients requiring cardiac surgery. These patients have a higher incidence of morbidity and mortality. Subsequently, diabetes represents a major medico-economic problem in both developed and developing countries. This study was designed to observe the association between glycemic control and outcome of patients after open heart surgery in adult population. Materials and Methods: Data was collected retrospectively in all patients who underwent open cardiac surgery (coronary artery bypass grafting, valve, or bypass grafting with valve surgery) and survived 72 hours postoperatively and had diabetes. The study was conducted from January 2015 to December 2016. Results: Of the 129 patients included in the study, male dominated 101 (78.3%). Most frequent surgery was coronary artery bypass grafting (CABG) 123 (95.3%), CABG plus aortic valve replacement 4 (3.1%), and CABG plus mitral valve replacement 2 (1.6%). Considering diabetes, only 3 (2.3%) were on diet control, 112 (86.8%) on oral hypoglycemic agents (OHA), whereas 9 (7%) had control on both insulin and OHA. Only 5 (3.9%) had type I diabetes. The mean fasting blood sugar (FBS) was 154.58 g/dl, and the mean duration of diabetic mellitus was observed 12.32 years. Microvascular and macrovascular complications were 26/129 (20.16%) and 17/129 (13.17%), respectively. Total 75 (58.1%) patients did not require insulin and 54 (41.9%) were treated with insulin intraoperatively to keep the blood glucose level less than 200 g/dl. Cardiac arrhythmias were frequent in the insulin group (P < 0.05), which was also associated with increased stay in the cardiac intensive care unit. Conclusion: Inadequate glycemic control during open cardiac surgery can possibly lead to increased perioperative morbidity and mortality and with decreased long-term survival and recurrent ischemic events. Therefore, aiming for blood glucose levels around 140 mg/dl appears reasonable. Further studies are required to define specific glucose ranges for a clearer definition of recommended blood glucose goals in postoperative cardiac patients for the best outcomes in patients with diabetes mellitus.
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Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.
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Context: Regional anesthesia may attenuate adverse physiological stress responses associated with cardiothoracic surgery. In this study, hemodynamic stress response at the different time of surgical stimuli was compared between patients receiving general anesthesia (GA) along with caudal epidural analgesia with GA with intravenous analgesia in pediatric population undergoing open-heart surgery. Aims: This study aims to compare the hemodynamic response at the different time of surgical stimuli and postoperative pain score, in pediatric patients undergoing open-heart procedures. Settings and Design: We designed a prospective randomized controlled trial to study hemodynamic effects between Group I and Group II. Fifty patients were randomly allocated equally into Group I (GA + caudal epidural) and Group II (GA + intravenous analgesia) by sealed envelope technique. Subjects and Methods: After obtaining approval from Institutional Ethical Committee, this prospective study was conducted in 50 American Society of Anesthesiologist Classes II and III pediatric patients aged between 1 and 12 years posted for cardiac surgery in our institution. Statistical Analysis: ANOVA, two-way ANOVA, and Student's test. Results: The heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure variations were compared between Groups I and II at different time intervals. The variations were found to be significantly higher at the time of skin incision and 2 min after skin incision in Group II as compared to Group I. Pain score was compared between the groups and was found to be significantly lower with Group I (2.5 ± 1.2) as compared to Group II (4.6 ± 1.7), P = (0.004). Conclusions: Caudal analgesia with GA (Group I) was found to have better hemodynamic control and significantly better postoperative pain relief in the first 24 h after awakening.
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Objective : Risk factors for SSI after open heart surgeries were evaluated in relation to a bundle of SSI preventive measures. Methods : Research design is a retrospective cohort study. The study population was 1,579 patients who had received open heart surgeries at Kobe City Medical Center General Hospital from January 2008 to December 2010 (Period I : when standard infection prevention measures were implemented) and from January 2014 to December 2016 (Period II : after a relocation of the hospital to a new campus and enhanced infection prevention measures were implemented). Factors associated with SSI were determined using univariate modelling analysis followed by multi-variate logistic regression analysis. The Center for Disease Control and Prevention definition of SSI was used for case determination. Results : Overall SSI incidence was 4.5%. SSI incidence decreased significantly from 6.6% in Period I to 2.9% in Period II (p＜0.001). Significant improvement in adherence to the recommended preventive measures was observed in Period II in selection of appropriate antibiotics, discontinuation of prophylactic antibiotics within 72 h after surgery and glucose control on post-operative Day 1 and 2 (p＜0.001). A univariate analysis showed statistical significance in surgical procedure, surgical period, surgical duration, post-operative day 2 morning glucose level, administration of prophylactic antibiotics within 1 h before incision, 100% compliance with the Bundle. Complex surgery (odds ratio 2.5 ; 95%CI 1.3～4.8) were identified as a risk factor by multiple logistic regression. Surgical period (Period II, odds ratio 0.41 ; 95%CI 0.28～30.71) and administration of prophylactic antibiotics within 1 h before incision (odds ratio 0.57 ; 95%CI 0.33～0.97) reduced SSI risks. Conclusion : The study demonstrated administration of prophylactic antibiotics within 1 h before incision was particularly important for SSI prevention. Higher compliance with SSI bundle and a special attention to patients receiving complex surgery were also warranted.
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Cardiac surgery induces severe postoperative pain and impairment of pulmonary function, increases the length of stay (LOS) in hospital, and increases mortality and morbidity; therefore, evaluation of the evidence is needed to assess the comparative benefits of different techniques of pain management, to guide clinical practice, and to identify areas of further research. A systematic search of the Cochrane Central Register of Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar, PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search premier was conducted retrieving 1875 articles. This was for pain management postcardiac surgery in intensive care. Four hundred and seventy-one article titles and 266 abstracts screened, 52 full text articles retrieved for critical appraisal, and ten studies were included including 511 patients. Postoperative pain (patient reported), complications, and LOS in intensive care and the hospital were evaluated. Anesthetic infiltrations and intercostal or parasternal blocks are recommended the immediate postoperative period (4–6 h), and patient-controlled analgesia (PCA) and local subcutaneous anesthetic infusions are recommended immediate postoperative and 24–72 h postcardiac surgery. However, the use of mixed techniques, that is, PCA with opioids and local anesthetic subcutaneous infusions might be the way to go in pain management postcardiac surgery to avoid oversedation and severe nausea and vomiting from the narcotics. Adequate studies in the use of ketamine for pain management postcardiac surgery need to be done and it should be used cautiously.
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In the cardiovascular surgery of infants,especially in complex congenital heart surgery,the advantages and disadvantages of blood supply and demand have gradually attracted clinical attention.Besides,allogeneic blood transfusion may lead to the infection of infectious diseases. As a result, how to minimize postoperative bleeding, reduce the usage of allogeneic blood products,and avoid the damage of blood has become a hot issue for urgent consideration and solution.The blood coagulation system of infants is not mature compared with adults, and the operation of congenital heart disease is becoming more and more complex, which makes the issue of maintaining the blood coagulation system of infants become increasingly prominent.This paper provides a reference for perfecting blood conservation strategy of infants with congenital heart disease, which systematically reviews the application progress of minimized extracorporeal circulation circuits, combined ultrafiltration technology,vacuum assist venous drainage,blood dilution and priming,utilization of antifibrinolytic drugs,and application of autotransfusion.
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Objective To explore the effect of two different core temperature monitoring methods on cardiopulmonary bypass and coagulation function in open heart surgery to provide a reference for monitoring the core body temperature in open heart surgery. Methods One hundred and forty patients undergoing open heart surgery in this hospital from June to December 2016 were divided into the control group(n= 70) and observation group (n= 70). The control group monitored the temperature of nasopharynx and bladder. The observation group monitored the temperature of rectum and nasopharynx. The temperature falling time of cardiopul monary bypass, time of blocking ascending aorta,time of rewarming, total time of cardiopulmonary bypass were recorded during operation. The coagulation function was monitored on 1 d before surgery and at the end of surgery,including thrombolytic time (TT), prothrombin time (PT) and activated partial thromboplastin time (APTT). Results The temperature falling time,rewarming time, total time of cardiopulmonary bypass in the control group were more than those in the observation group, the difference was statistically significant(P<0.01);there was no statistically significant difference in coagulation function indicators(TT,PT,APTT) before operation between the two groups (P> 0.05). At the end of the operation, the coagulation function indicators (TT, PT, APTT) had statistically significant difference between the two groups (P<0.01). The coagulation function indicators in the observation group were better than those in the control group. Conclusion Using the rectal temperature for monitoring the core tempera ture in the patients undergoing open heart surgery under cardiopulmonary bypass is better than using bladder temperature, which can shorten the time of cardiopulmonary bypass and improves coagulation function.
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Objective To observe the myocardial protective effect of dexmedetomidine in patients undergoing open-heart surgery under cardiopulmonary bypass (CPB).Methods 50 patients of open-heart surgery under CPB were randomly divided into two groups equally, namely observation group and control group.Observation group was treated with injection of dexmedetomidine at 0.5 μg/kg for 15 min, and then maintained at 0.4 μg/kgoh.The control group was given equal volume of normal saline.Concentrations of IMA and cTnI were determined before anaesthesia (t0), after 30 minutes of CPB (t1) and after surgery (t2).Results IMA and cTnI concentrations of t1 and t2 in the observation group were significantly lower than those in the control group (P<0.05).Conclusion Dexmedetomidine has obvious protective effect on myocardium, which can reduce open-heart surgery of patients with myocardial ischemia reperfusion injury (MIRI).
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Objective:To analyze the curative effects of resection by traditional thoracotomy and thoracoscopy for senile peripheral lung cancer.Methods:65 patients with peripheral lung cancer were randomly divided into traditional thoracotomy surgical group and thoracoscope group.Operation protocol are in accordance with established grouping scheme,compare two groups of patients with general attribute data.indicators related to the operation.Postoperative follow-up last to June 2016,Kaplan Meier-method is used to evaluate patients' 5 year overall survival (OS) and relapse-free survival (RFS).Results:The thoracoscope surgery group operating time significantly longer than thoracotomy group (p＜0.05).The time of intrathoracic drain in thoracoscope group was obviously shortened (p＜0.05).The loss of blood in thoracoscope group is less than thoracotomy group (p＜0.05).Postoperative complications such as VAS score decreased,and the hospitalization time is shorter than thoracotomy group (p＜0.05).But the thoracoscope hospitalization expenditure is more expensive than thoracotomy group (p＜ 0.05).RFS of thoracotomy group for five years was 65.27％,and the thoracoscope group was 67.13％:there was no statistically significant difference (p＞0.05).Thoracotomy patients OS for 5 years was 53.73％,the thoracoscope group was 55.34％,the difference was statistically significant (p＜0.05).Conclusion:Compared with the traditional thoracotomy surgery,blood loss is more than lung cancer resection under thoracoscope.Thoracoscope make the patient recover faster.
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<p>The patient was 70-year-old man. Distal aortic arch aneurysm of the maximum diameter of 55 mm was pointed out by Computed tomography. He underwent total arch replacement with median sternotomy. The next day, white cloudy fluid was flowing out from his left thoracic drain, and the amount increased and chylothorax was diagnosis. We selected conservative therspy with fasting and octoleotide subcutaneous injection. After 19 days chylothorax did not improve. We performed percutaneous thoracic duct embolization which is minimam invasive therapy. After embolization, he could start the meal, and the chest drain was extubated. He was discharged in good condition 49 days after first operation.</p>
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Background and Objectives: Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery. Methodology: Fifty infants <6 months of age were prospectively randomized in the trial for enteral nutrition (EN) postoperatively from day 1 to 10, after obtaining the Institute Ethics Committee’s approval. They were equally divided into two groups on the basis of the feed they received: Control group was fed with expressed breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM + energy supplementation/fortification with human milk fortifier (7.5 kcal/2 g)/Simyl medium‑chain triglyceride oil (7.8 kcal/ml). Energy need for each infant was calculated as per EER at 90 kcal/kg/day, as the target requirement. The intra‑ and post‑operative variables such as cardiopulmonary bypass and aortic cross‑clamp times, ventilation duration, Intensive Care Unit (ICU), and hospital length of stay and mortality were recorded. Anthropometric and hematological parameters and infection control data were recorded in a predesigned pro forma. Data were analyzed using Stata 14.1 software. Results: The duration of mechanical ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS), infection rate, and mortality rate were lower in the intervention group compared to the control group although none of the differences were statistically significant. Infants in control group needed mechanical ventilation for about a day more (i.e., 153.6 ± 149.0 h vs. 123.2 ± 107.0 h; P = 0.20) than those in the intervention group. Similarly, infants in control group stayed for longer duration in the ICU (13.2 ± 8.9 days) and hospital (16.5 ± 9.8 days) as compared to the intervention group (11.0 ± 6.1 days; 14.1 ± 7.0 days) (P = 0.14 and 0.17, respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days, respectively, in the intervention group compared to control group. The infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in the intervention group than those in the control group. The energy intake in the intervention group was 40 kcal more (i.e., 127.2 ± 56.1 kcal vs. 87.1 ± 38.3 kcal) than the control group on the 10th postoperative day. Conclusions: Early enteral/oral feeding after cardiac surgery is feasible and recommended. In addition, enriching the EBM is helpful in achieving the maximum possible calorie intake in the postoperative period. EN therapy might help in providing adequate nutrition, and it decreases ventilation duration, infection rate, LOIS, LOHS, and mortality.
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Objective To explore causes of fever in patients after the surgery for congenital heart disease(CHD), and put forward corresponding prevention and control measures.Methods Clinical data of patients undergoing sur-gery for CHD in the department of pediatric surgery of a hospital between January and May 2013 were analyzed ret-rospectively,the whole process of operation and postoperative nursing were observed,environmental hygiene moni-toring was performed at the same time.Results 26 patients all had fever after operation,fever in 21 cases (80.77%)was caused by non-infectious factors,5(19.23%)by infectious factors (ventilator-associated pneumonia in 4 cases,type I incision infection in 1 case).6 cases were absorption fever,20 were abnormal fever,difference in patients’age,duration of invasive manipulation (ventilator,urinary catheter,gastric tube)between two groups of patients were all statistically significant (all P <0.05),patients in the absorption fever group were with older age and short invasive manipulation time.Bacteriological detection rate in 26 patients was 76.92% (n=20),a total of 58 specimens were detected,7 were positive (from sputum specimens of 4 patients),5 isolates (71 .43%)were Pseudomonas aeruginosa .A total of 52 environmental specimens were collected for detection,the qualified rate was 80.77% (n =42).Conclusion Non-infectious factors are the main causes of postoperative fever in patients with CHD,health care workers should enhance the awareness of sterilization,standardize all kinds of medical manipula-tion,and reduce postoperative fever.
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<p>Central diabetes insipidus (CDI) is a disease that caused by insufficient or no anti-diuretic hormone (ADH) secretion from the posterior pituitary, which results in an increase in urine volume. CDI is controlled with ADH supplementation thereby reducing urine output and correcting electrolyte imbalance. However, reports on perioperative management for CDI patient are scarce, especially for patients who underwent cardiac surgery. We herein report our experience of the management of a CDI patient who underwent surgery for valvular heart disease.</p><p>The case is a 72-year-old woman who developed secondary CDI after pituitary tumor removal. She had been controlled with orally administered desmopressin acetate hydrochloride. She underwent aortic valve replacement and mitral valve repair for severe aortic, and moderate mitral regurgitation. Immediately after surgery, we started vasopressin div, which yielded good urine volume control. However, once we started to switch vasopressin to oral desmopressin administration, the control became worse. We thus made a sliding scale for subcutaneous injection of vasopressin every 8 h according to the amount of urine output, which resulted in good control. Overlapping administration of vasopressin and oral desmopressin between postoperative day 12 and 17 resulted in successful transition. The patient was discharged with oral desmopressin administration. Management with sliding scale for vasopressin subcutaneous injection after surgery was useful in controlling a CDI patient who underwent major cardiac surgery.</p>
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BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
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Adult , Humans , Blood Transfusion , Bloodless Medical and Surgical Procedures , Heart Valves , Jehovah's Witnesses , Mortality , Perioperative Care , Survival RateABSTRACT
A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921–1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book.
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Humans , Heart , Korea , Seoul , Thoracic SurgeryABSTRACT
BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
Subject(s)
Adult , Humans , Blood Transfusion , Bloodless Medical and Surgical Procedures , Heart Valves , Jehovah's Witnesses , Mortality , Perioperative Care , Survival RateABSTRACT
Background: Coagulopathy is a major issue in children undergoing high‑risk pediatric cardiac surgery. Use of anti‑fibrinolytics is well documented in adults, but recently there are questions raised about safety and effectiveness of their use on routine use. Tranexamic acid is a potent anti‑fibrinolytic, but its role is not fully understood in children. This study aims to study the benefits tranexamic acid in controlling postoperative bleeding in pediatric cardiac surgical patients. Methods and Results: Fifty consecutive children who underwent cardiac surgery were randomized prospectively to receive either aprotinin (Group A; n = 24) or tranexamic acid (Group B; n = 26) from September 2009 to February 2010 were studied. Primary end points were early mortality, postoperative drainage, reoperation for bleeding and complications. Mean age and body weight was smaller in Group A (Age: 48.55 vs. 64.73 months; weight 10.75 vs. 14.80 kg) respectively. Group A had more cyanotic heart disease than Group B (87.5% vs. 76.92%). Mean cardiopulmonary bypass time (144.33 vs. 84.34 min) and aortic cross‑clamp time (78.5 vs. 41.46 min) were significantly higher in group A. While the blood and products usage was significantly higher in Group A, there was no difference in indexed postoperative drainage in first 4, 8 and 12 h and postoperative coagulation parameters. Mean C‑reactive protein was less in Group A than B and renal dysfunction was seen more in Group A (25% vs. 7.6%). Mortality in Group A was 16.66% and 7.6% in Group B. Conclusion: Anti‑fibrinolytics have a definitive role in high‑risk children who undergo open‑heart surgery. Tranexamic acid is as equally effective as aprotinin with no additional increase in morbidity or mortality. Ultramini Abstract: Coagulopathy has been a major issue in pediatric cardiac surgery, and anti‑fibrinolytics have been used fairly regularly in various settings. This study aims to evaluate the efficacy of tranexamic acid as compared against that of aprotinin in a randomized model. Tranexamic acid proves to be equally effective with less toxicity with no added mortality.
Subject(s)
Aprotinin/administration & dosage , Cardiac Surgical Procedures , Child , Child, Preschool , Hemorrhage , Humans , Infant , Infant, Newborn , Mortality , Tranexamic Acid/administration & dosageABSTRACT
According to the 2013 WHO survey, the world’s leading cause of death is a coronary heart disease which is accounted for 12.9%. Bypass surgery by grafting Artery mammaria interna to the left anterior descending coronary artery is more clinically significant and has long become an international standard. Aim: To study the outcomes in patients who undergone a bypass surgery ofgrafting the Artery mammaria interna to the left anterior descending coronary artery in an open heart surgery. In 2014 in the case-control study conducted at the Shastin 3rd National Central Hospital, 8 patients who undergone a bypass surgery of grafing Artery mammaria internasinistra to the left anterior descending coronary artery were selected for a case group and 8 patients with bypass grafting of a superficial vein of the leg to the coronary artery were selected as a control group. Related diseases, heart function, type of grafting performed, and post-operative complications were studied. The successful bypass surgeries of grafting the Artery mammaria interna sinistra to the left anterior descending coronary artery without complications in the case group in 2014 has demonstrated that the Mongolian cardiosurgical team was able to successfully and fully introduce this innovative approach that has become an international standard of coronary artery surgery. The introduction of this method enables to eliminate angina pectoris symptoms in patients, restore and improve heart contractions, reduce the chances of a repeat heart attack, and thus, to improve the patient’s ability to live and work normally.
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PURPOSE: The purpose of this study was to examine the effects of prior information about ICU environment on the anxiety and environmental stress of cardiac surgery ICU patients. METHODS: A non-equivalent control group non-synchronized quasi-experimental research design was used. Participants were 60 (control 30, experimental 30) patients who had been admitted to ICU. Prior information about the ICU environment was provided to the experimental group. The anxiety level of subjects was measured by State-Trait Anxiety Inventory (STAI) and the stress level of subjects was measured by the Intensive Care Unit Environmental Stressor Scale (ICUESS). Data were analyzed using a Chi-square test or a Fisher's exact test, independent samples t-test, and paired samples t-test. RESULTS: There was no difference in Anxiety (t=-0.58, p=.563), but there was a significant difference in environmental stress (t=10.46, p<.001). CONCLUSION: Providing prior information would be an effective nursing intervention to reduce environmental stress.